Registered Nurse Counsellor Mary Begg Health Services

ROLE DESCRIPTION

At MBHS, our nurse counsellor will have the primary responsibility of coordinating and providing all aspects of care for patients affected with HIV/AIDs in the community. He/she will provide services in the form of patient education, counselling and testing, HIV prevention and outreach, adherence support, physical health assessments and individual level risk reduction counselling. He/she is an expert in the field of HIV/AIDS counselling, testing, diagnosis, treatment and adherence support.

Our nurse counsellor is a qualified registered nurse who carries out his/her duties consistently, ethically and in line with national and international standards and evidence based clinical practices. All qualified nurses must adhere to the General Nursing Council of Zambia’s Code of Conduct as well as the MBHS Code of Conduct and must practice safe, ethical and evidence based nursing care at all times as dictated by the MBHS Healthcare Standards.

KEY RESPONSIBILITIES

Clinical Services

• Must have thorough knowledge on national guidelines, standard operating procedures and quality assurance systems as well as MBHS protocols and procedures relating to HIV/STIs/AIDs TB, counselling and testing and EMTCT, B+ program.
• Be the focal point person and resource person at the HIV/ART clinic for patients and families, MBHS staff and clients.
• Perform under the supervision of a senior medical doctor and the Chief Medical Officer (CMO).
• Create a system to record and monitor new referrals and follow-up visits to an approximate caseload of 100-150 patients. This system should be reviewed every 3 months and audited.
• Perform physical examinations like blood pressure, pulse, temperature, weight checks and health histories for all new patients. Nursing assessment, examination and routine patient vital signs observations are clearly documented according to the clinic’s standard operating procedure.
• Develop a comprehensive individualized service care plan for clients on ART that reviews eligibility criteria for ART initiation, adherence support, initial and repeat laboratory testing, medication/prescription pick-ups, referrals to family planning, prophylaxis and management of opportunistic infections, screening for tuberculosis, ART treatment failure etc.
  Conduct detailed revaluation of the patient service care plans to ensure its effectiveness.
• Ensure that all patients receiving ART treatment have an ART monitoring and follow-up clinical chart that is updated after each visit.
• Provide patient education on the proper administration of ARVs and discuss serious risks resulting from non-compliance. Observe for any adverse reactions or side effects related to medications. Document all findings and notify the medical doctor as required.
• Review medication history and current orders. Ensure any change in medication is properly recorded in the patient’s medication chart and inform pharmacy accordingly.
• Work closely with pharmacy staff so that repeat prescriptions can be collected at pharmacy if no review is required at that time.
• Conduct oral and/or intravenous blood testing for the detection of HIV antibodies, only within scope of practice.
• Ensure that all ARV medications received from the District are always stored and locked up in the pharmacy.
• Prescribe ARVs medications only within HPCZ scope of practice and as directed by the CMO.
• Ensure that patient consent forms are explained and signed prior to any testing and treatment. All consent forms are filed in the patient’s medical folder.
• Maintain proper and legible nursing documentation and charting, in keeping with best practice guidelines and MBHS Healthcare Standards.
• Respond quickly to emergencies.  Involve the medical doctor or doctor on-call immediately if there are any urgent or emergency patient cases.
• Ensure that all completed patient documentation is securely entered into the patients’ medical file; this includes, but is not limited to, consent forms, care plans, nursing/consultation notes, ARV monitoring forms, medication chart, laboratory results etc.
• Identify and maintain working relationships with potential external testing sites.
• Develop an efficient system to track patients who are non-compliant with the program.
• Must understand the B+ program and educate mothers to be about early intervention.
• Conduct outreach activities to reach hard to reach communities where directed by the CMO or Clinic/Hospital Manager.
• Identify and communicate abnormal patient results to the medical doctor or CMO within two hours.
• Follow proper disposal procedure for expired ARV medications per company policy.
• Manage ARVs logistics and information systems, dispense ARVs and offer adherence support to patients on HAART.
• Promote ways to ensure patient confidentiality and anonymity with regards to appointment attendance, laboratory testing and pharmacy prescription pick-ups.  All counselling and testing of patients is carried out in a private consultation room to facilitate confidentiality.
• Always keep up-to-date on changes in national guidelines/ recommendations related to HIV care and support, and discuss and facilitate these amendments with the CMO.
• Promote good health through patient education and document this in the patients’ medical file.
• Continually demonstrate adherence to the Infection Control Policy, especially maintaining proper hand washing technique. Use and maintain correct personal protective equipment (PPE) such as gloves when handling patient blood/bodily fluids. Discard disposable gloves after each patient use.
• Comply with all national legal regulations as stipulated by the GNC and HPCZ.
• Ensure compliance for other duties and responsibilities as may be required from the Chief Medical Officer and/or hospital/clinic manager from time to time and as part of your role.

Customer Service 

• Foster a culture of customer service satisfaction amongst MBHS staff and patients. Attend mandatory customer service training.
• Demonstrate good customer service by listening to patient’s concerns and providing proper support and care. Be polite and respectful in all patient or staff interactions.

Administrative Functions and Reporting

• Monitor, evaluate and review quality assurance/ quality improvement tools designed for the HIV service.
  With support from the CMO, conduct quarterly (or as requested) HIV/ART service self-audits and submit results to the Quality Department at Head Office.
• Report monthly on HIV patient caseload figures for new referrals, follow-up consultations, repeat laboratory testing, access to scheduled CD4 testing/ viral load testing etc.
• Attend weekly clinic meetings to report on and discuss issues relating to improvements to the HIV/ART services. Minutes of these meetings are recorded.
• Create, maintain and regularly update the pre-ART register, ART register, daily activity register and Chronic Disease Register (with support from pharmacy).
• Recommendations from previous service reviews/ audits are implemented with a clear plan of action.
• Daily statistics on the number of patients seen each day are sent to the CMO as advised.